Dental Aerosols: Protect Your Team, Yourself, and Your Patients





By Lexi Marino June 4, 2020

Rolando Mia, from Zyris, hosts a video series focused on the latest news, topics, and conversations happening in dentistry featuring dentists across the nation. We had the opportunity to talk with newly practicing dentist Dr. Igor Lantsberg where he gave us an inspiring explanation on why it’s mission critical to reduce dental aerosols.

Watch this video to learn the following:

  • Why going the extra mile to reduce dental aerosols will define the future of your practice
  • How patient safety is evolving
  • What types of products or technology are essential in reducing dental aerosols

Transcript

Rolando Mia:

Good morning everybody and welcome to Dental Voice. My name is Rolando Mia and this is Zyris. Today we have a special guest, kind of excited to get some insights from Dr. Igor Lantsberg. We work with literally thousands of clinicians and there’s a lot of information, experience and wisdom that they have to share. Dr. Igor is a young dentist who just recently graduated from Stony Brook, finished his residency down in Long Beach, CA, and just started his career. This is going to be fun, really looking forward to spending some time with him. Welcome Dr. Igor Lantsberg. How are you doing sir?

Igor Lantsberg:

I’m doing well. Thanks for having me on.

Rolando Mia:

What I’d like to start with first of all is your experience of when you were in dental school and then starting in your residency, where COVID-19 didn’t exist whatsoever. From your perspective, how would you say it’s affected kind of the experience that you’re dealing with right now? And what are your thoughts on that?

Managing COVID-19 as a New Dentist

Igor Lantsberg:

Yeah, it’s completely different than dental school. And even in residency, we had a lot of infection control classes and lectures. They had to bring us up to date and really teach the basics. Right? It was something that I think students really, they didn’t want to really listen to that as much as the clinical hands on stuff. Right? It was always in the background. We know what’s the clean side, the dirty side. I finished Stony Brook knowing what I needed to do with airborne pathogens and bloodborne pathogens. However, this has really just completely changed.

As a new dentist now working 2 days a week to 3 days a week, I really have to be aware of what’s going on and how to take the basics that I learned and really apply them. It’s more like, instead of the clinical knowledge that we learned, it’s more of the stuff that we didn’t really pay attention to too much and are really applying it now.

Rolando Mia:

Well, I appreciate that. I can only imagine. From an operational perspective, you are taught certain things in dental school and the VA is phenomenal at infection control and maintaining a very stringent level of that. What has changed from your perspective and what do you personally do to make sure that you’re safe, your patients are safe, and that type of stuff?

Igor Lantsberg:

Before, we wore masks and we wore loops and we again had all been basically detached from that. Now with N95 masks are a priority, face shields are a priority. We really have to be aware of what we touch – if we adjust our loops. We have to be aware for not just our safety but for the patients, for the assistants, and for the staff. It’s more just being prepared going from patient to patient and we limit the number of patients that we see now.

So, if we have more time to prepare and adjust ourselves, see the new patients and make them feel comfortable, make us feel comfortable. Right now. we check every patient’s temperature. Before I go in, the assistant sees them first, so I have the assistant ask them a few questions on whether or not they’ve been staying inside or if they have been exposed to anything unnecessary. So, we have to really take really serious precautions here. That’s the really big difference for lot of people now.

Advice for Dental Students Currently Graduating

Rolando Mia:

So, you’ve got a lot of dentists right now who are about to graduate from dental school or in the midst of their residency. Based on what you’ve experienced so far and the things that you’ve been dealing with, what advice or what kind of feedback would you want to give those dentists? First to the ones who are in dental school who are about to come out and then to the dentists that are in residency who are probably going to start trying to figure out how to start their career.

Igor Lantsberg:

I personally think it’s going to be really challenging to find a job. I’m not saying it’s going to be completely unworkable, but I think it’s going to be harder then when I was looking for a job. I was in a pretty interesting situation because I actually just started a new job March 16th, so right before everything blew up.

My first day in a new office was March 16th, so I’m still a new dentist, right? In the eyes of many. So, let’s say I just came of residency and I started this new job and this whole thing blew up. And now what? Right. I have a certain guaranteed daily guarantee, right? Because I don’t have my own patient base. So, that was thrown out the window. A lot of the promises, a lot of the things that were supposed to happen really didn’t pan out – didn’t go through. I think, for a new dentist, if they get a new job, we have to realize that this is a reality. Even going forward, several months to even a year this is what life is going to be like for the dental profession, really cautious, really being prepared for seeing mostly emergencies. We have to get back into the flow of really doing regular dentistry.

Rolando Mia:

So, if I understand you have to be prepared because the reality is quite different, right? From what you thought it would be and yeah, it’s definitely going to be hard, but it’s also there’s a perspective that you have to have going into this. Is that kind of where you were going with that?

Igor Lantsberg:

That’s right. That’s it, you know, as a new dentist you’re always swayed and persuaded. Right? I would say stick to what you know, you’re a dentist, you know a lot. You have your own morals and ethics. So, whatever anybody really does, have facts behind you. Have a conversation with the person that’s trying to employ you, who you’re working with and say, “Listen, I’m not comfortable with this because of A, B, and C, or I think it should be this because a, B, and C, that’s what I did.” I had to step up in my dental practice being really brand new in the office. We had other doctors there who didn’t want to work in the current environment. So, I really had to step up.

I had to be the one that led the staff, the dental assistants and I dictated who I wanted to see, you know? I had a lot of conversations with my employer about what he wanted from me and what I’m comfortable with and everything was by CDA guidelines. He respected that. So, I think for a new dentist coming out or even in residency, just be confident in what you believe in and you know, and I think it’ll work out. It’s just nobody really knows how to handle all of this, so nobody’s right. Just be cautious and be protected.

A Change We All Did Not Expect: COVID-19

Rolando Mia:

That’s great. I really appreciate that. It’s, it’s amazing. It requires courage and that’s a key piece that I got out of there. Have confidence in what you’ve learned and basically have the ability to have an open and meaningful dialogue with those around you. Did that I catch that? So how do you, because it is completely different, when you think about change and dental aerosol, when you think about things that you never expected, the prospect of not knowing about really can, can lead to a lot of stress and anxiety. How is that affecting you and how is that making you feel right now?

Igor Lantsberg:

You know, I wasn’t too worried with everything that was going on. I’m a young guy, I’m not in much danger if I get exposed, but it’s those around me, right? I don’t want to spread it around. So, that was always in the back of my mind. What if I do get infected? Is my staff exposed to it – all my, you know, patients, dental assistants, when I come home or pass my neighbors? It’s that stuff that I’m concerned about really. I don’t know if I answered that question, but at least the knowledge of the unknown. We still don’t know a lot about this, how it’s really going to be controlled in the future. I think a lot is going to change and it’s kind of going to be interesting after that.

Rolando Mia:

That’s cool. How do you keep yourself and your team motivated? How do you, because you know, you’re the dentist, you’re the person that they’re looking to, they’re looking to you to kind of say, “Hey, come on, let’s go.” How do you keep yourself motivated? How do you motivate your team? What are some of the things that you think about when you do that?

Igor Lantsberg:

Well, when we see a patient, they’re so appreciative of anything we do. We’re seeing a lot of emergencies and a lot of limited exams. When they come in and we get them out of pain or at least just do an exam and talk them through whatever they need, they’re so thankful. So that’s really, coming back in and seeing those emergency patients that have a swelling or they can’t sleep at night. They can’t eat, they can’t function. That’s what’s really motivating me.

They’re in the beginning of all of this. Obviously, the dental profession is super exposed, right? A lot of dental offices closed. They just don’t know where to turn. So when we think about everybody that we’re helping, that kind of pushes you forward. We’re still essential. I mean, dentistry as a medical field. I don’t know if you’ve ever been in dental pain, but it’s not fun.

Finding the Right Information About Dental Aerosols

Rolando Mia:

You know, you’re talking to one of the worst patients on the planet. I work in the industry and I completely understand and resonate with that. You’re right, when you are in pain and you come in and see your doctor and realize, “you helped me.” It is very grounded. It just feels great cause you’re doing that. I can totally see how that can be very motivating and helpful to the team. So thank you for that. Appreciate that. That’s, that’s kind of cool.

So, it’s interesting you mentioned there’s so much information out there regarding dental aerosols, there’s so much that you’re hearing. I suspect that there is a component of it that’s real and there’s a component of it that’s speculative and then there’s a component of it that’s probably all just not true. What advice would you give people regarding what to listen to and what not to listen to and all that type of stuff?

Igor Lantsberg:

I think you have to kind of absorb information as you can, right? There’s a lot of speculative data out there. I know some people that don’t even believe that aerosols transmit the virus. So, I mean, a little extreme, especially, if we’re in the dental field. It’s everything that you take, think about aerosols, right? Even if it’s speculative, right? I mean, there’s so much that’s happening. It’s spreading so fast and you want to stay protected. You want to protect everybody else. So, just take the necessary precautions and be safe. You know I work with the Isovac when I’m in the office. I know how much aerosol there is and how much splatter there is when we work in the patient’s mouth.

I want to reduce the aerosol. I mean for those that don’t believe that the virus can be transmitted, I mean, they don’t try to protect themselves in that way. You know, they still use an N95 mask hopefully. But I want to go the extra mile. You know, I want to protect everybody around me. I just actually found out maybe last week that two of my assistants have underlying conditions. So one of them has asthma and the other one has diabetes. I didn’t realize that because again, I’m new, I’m still trying to remember all the names, but you know, I’m like, “What are you guys do in here?” And then, you know, they need the money, they need to work. So. I can’t blame them for that.

Whatever we can do to really minimize any type of unnecessary exposure, we have to, okay? I think that’s where dentistry is really going to go. There are studies that show the aerosol staying in the air suspended for hours. I don’t know how the ventilation systems are in most offices, but I don’t think they’re great. There’s really nothing we can do about that. Let’s we completely gown up and have all of the protection and everything, right? And then it’s still in the air. We’re not outside. There isn’t a breeze that takes these particles somewhere else. So, I think the danger is there and I think we have to be aware of it.

We have to read up on it. So whatever’s unknown is going to be known hopefully sometime soon. And listen before we have any kind of concrete serological testing, we just have to be prepared. I mean, there’s so many, there’s asymptomatic patients walking around everywhere. Even taking a temperature, even asking, “Have you been sick lately?”. We might still be exposing everybody around this. So, take it as is. Just be well prepared.

Rolando Mia:

So that’s cool. It’s interesting in the absence of information it sounds like if I got this correctly, it’s important to be completely prepared, kind of the context of prepare for the worst, expect for the best. Is that kind of the logic behind it and make sure you’re completely prepared, make sure you’re protected, ask the questions?

Protecting Yourself From Dental Aerosols

Igor Lantsberg:

I think so. I think dentistry – it’s completely changed, right? Everybody’s talking about it. What’s going to happen, right? I mean there’s some that believe that our basic PP is going to be fine and it’s you know, maybe with, obviously with a N95 mask, but there’s those, that think that we have to be in complete suits and complete, masks and a scuba outfit. It’s crazy. Right? We also have to realize that, you know, this happened before, right?

This happened with the Spanish flu a hundred years ago. What happened with the Spanish flu? It just doesn’t just disappear. I’m sure people took the same precautions. They were staying away from each other and everything like that, but it basically just faded away. People more and more people got exposed to it. So, I don’t think dentistry needs to change and I don’t know how I swayed, like got into this a topic.

I don’t think that it needs to really change completely and entirely – their protocol in terms of just wearing suits and getting, kind of getting into like this operating room status. However, being more prepared than usual, being more aware, at least right now before we can do any kind of testing before we can know for sure that whoever’s coming in is safe and we’re not in any harm. We have to test ourselves as well. I think we’re doing that, and we should strive for that. That’s my thought on it. Everybody has some opinion and even in my own company, there’s contrasting thoughts and what should we do and how little by little we should see more patients and try to do that.

But again, it’s like if you’re not protecting or at least trying to protect as best you can, those around you. I mean, that’s what we’re trying to do for the greater good. Everybody’s making sacrifices in the Italian community. So if there’s pockets of places that are really not abiding by that – it’s not right. I think it’s irresponsible.

Rolando Mia:

I appreciate that. You’re right, there are always going to be contrasting views. You’re going to have people who are completely freaked out and people who are saying, “Yeah, this is kind of crazy.” I hear it correctly based on what you said earlier. It’s important to be clear about who you are and have the courage to drive it from that perspective. Right? I love that message because it’s not about just believing. It’s taking that information and making sure that you kind of balance it with what your thoughts are. So thank you for that. And I appreciate that. So, you mentioned that you use system the Isolite or the Isovac. Do you see it actually decreasing or helping with aerosols and spatter? Have you personally seen it?

Igor Lantsberg:

I used it in dental schools in Stony Brook a little bit. I remember I really loved it. After that I didn’t use it. I didn’t use it in my VA or for the half a year, more than eight months that I worked in a different practice. But now I have it in this office, I know what it does, and I know how much it reduces aerosols. I could see it helping me a lot because. I can’t see the aerosols in the air, I know how much it helps me see and it helps reduce saliva that’s redirected out of the mouth. Right?

Rolando Mia:

Well, you have. One of the things we’re hearing is constant evacuation is really important because even as a patient or as a person is breathing, they’re actually generating aerosols. When you think about COVID-19 it starts in the lungs. The important part, I think it was Rella Christianson, who has been a huge advocate. We had another clinician, Michelle Strange on our show, and she was saying, you can do to minimize the potential for aerosols escaping to the patient – you want to do that. Especially, you mentioned some of these patients are asymptomatic, so you could be you, me and I could be a carrier and I don’t know.

The Importance of Continuous High Volume Evacuation

Igor Lantsberg:

It is advised by the ADA to work with a rubber dam for emergencies. I think the Isovac is does that just as well. It covers the throat. The coronavirus is in the nasal pharyngeal mucosa. It’s in saliva, right? So, if we could prevent that, that splatter in the air. Why not? We need to as healthcare professionals. We are obligated to be safe and make sure the patient is safe. There’s a study that actually I actually read yesterday, it’s in the New England Journal of Medicine and they believe that this could even be spread by speaking, by just speaking.

I mean the aerosol particles are large when you cough and when you sneeze. But there’s certain droplets or air particles that are made when you speak and they’re saying or testing it with lasers and they’re saying like, “Say healthy.” And so, when you say this there are little particles. They’re so little, so small that they stand there in the air longer because you know, the gravity just doesn’t take them down. So, if we could reduce any type of splatter – we don’t have ventilation systems, good ventilation systems. We have to kind of go into the future. I don’t know if dental offices are going to have to get a new whole new ventilation system installed.

The whole structure has to be changed. But I think that’s a little too dramatic. I think in time, like I was saying before in time I think it’s going to pass. I think enough of the population’s going to get it and develop antibodies we’re going to get to become a thing of the past – just like with the Spanish flu. If the Spanish flu never went away, we would’ve been in mess. Right now, it’s like, a few years have to pass, I think for enough of the populations and get it, then we’re going to be fine. We’re going to feel comfortable again.

Rolando Mia:

Cool. Thank you for that. So, shifting gears slightly, so we’re experiencing this now, you’re early in your career, I suspect you have aspirations to start your own practice or join another one Based on everything that you’re experiencing now, how has this changed that perspective and what are some of the shifts in your thinking with regard to how you go forward and navigate?

Igor Lantsberg:

Yeah, I mean right after residency and starting practice, I always imagined having a dental office, “When can I get a dental office?” I always encourage young dentists and I was encouraged to become an owner because that’s how you grow and that’s how you have full autonomy. That’s really the goal, right? With all of this moving forward, that has to be dialed down back a little bit. I think it’s going to get harder, personally. I don’t know about everybody else, but at least I’m eating through my savings right now. There are only 2-3 days a week. For those that want to start new offices, a new practice, a lot of things need to be considered.

Being well prepared you know, being protected and showing that the patient can be protected can be a great marketing, right? I mean, they could get a lot of patients if they say, “I have a great ventilation system, I use the Isolite and Isovac, I use all of these measures that can protect you.” So, the patients, they’re not going to forget about this anytime soon. They could there could really be swayed by that. So, I think it’s going to be harder to open up a practice. I don’t think it’s going to be impossible. I think loans right now are super low, but it’s whatever you feel comfortable with. It’s going to be a tough environment. It was always tough to open a practice. Now it’s going to be even harder, right? I mean the economy’s down. So, are people are going to want to go in and do routine dental work? I don’t think so. Build a practice on emergency care and it’s going to be tough.

Being Open and Honest in Your Profession

Rolando Mia:

No, I appreciate that. It’s the prospect, especially entering into a space like this, I can only imagine how that is. I really appreciate you sharing and being so honest about the things that are going through your head. You’re right. There’s the reality of the situation is that there’s a lot of unknown and things are crazy. It’s really important to weigh things and then be very focused about what that looks like. Thank you for sharing that. I very much appreciate that you’re being so honest about it. A lot of times people come on and they’re like, “No, this is the best. This is great. Everything’s okay.” However, there’s still that reality underneath it and there needs to be a balance.

So, thank you for being open with us and sharing the perspective that you have. A lot of times, you feel compelled to ignore things and you’re also being openminded with regard to what’s out there. So, as a way to wrap it up or bring this back together for our listeners, how would you pull this together and what closing statements would you have with regard to what’s happening here? Any advice to the young dentists and kind of how to kind of get through this?

Igor Lantsberg:

Are you putting me on the spot for a closing summary over here? For the new dentists and those are just coming out, stay positive. Stay positive and stick to what you know. You might be swayed to do things that you’re not comfortable with. I think if you’re confident in your abilities and your knowledge you’re going to have a much easier time internally pulling through all of this. I know a lot of dentists that are not working right now. They don’t know what to do or how long they’re not going to be working. But I took a stand actually with my employer.

I didn’t want to do some of the stuff that I was being encouraged to do and was applauded for that. It was such a positive for me. I spoke to a lot of friends, I spoke to my colleagues and they were like, “He did the right thing.” So, I would say stay positive. Stick to what you know. This is all going to pass. This is unfortunately our reality right now. But if you’re well prepared, you’re going to succeed. You’re going to do well, and patients are going to respect that and applaud you for that.

Rolando Mia:

First of all, thank you. I love the message behind that. The sentiment is people don’t care how much you know until they know how much you care, and you clearly care a lot. I think that’s very clear based on the comments you’ve given us. So thank you and thank you for sharing and thank you being for being so open about that. So that was awesome. Well done. So, if people have questions or want to reach out to you what would be the best contact information or are you open to answering questions if people have them and they want to contact you directly?

Igor Lantsberg:

Via email. It’s I.lants@yahoo.com.

Rolando Mia:

Awesome. So if you have any questions, please do that. Those of you who are here, listeners, thank you for joining us. I really appreciate the direct and very honest feedback that you’ve given us. This is awesome. I love the message about,“Hey get yourself together. Be clear about who you are and we’re going to get through this.” That’s a great message to get out there. If you like the content here, or if you have any additional topics that you’d like us talk about, please send us messages. If you like this, please feel free to share it. And Dr. Lantsberg, it’s a pleasure spending some time with you – stay safe, be well good luck. I feel very strongly that your patients really appreciate everything that you’re doing, so thank you for that. All right take care everybody. Bye.

 

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